,NUR 176 Advanced Prep: Master Adult
Health & Complex Nursing Care Practice
Questions
Subject: Acute and Chronic Adult Health Alterations (NUR 176)
Question 1: A patient with advanced COPD presents with increasing confusion, lethargy, and a
respiratory rate of 8 breaths per minute. Arterial blood gas (ABG) results are: pH 7.24, PaCO2
68 mmHg, and HCO3 28 mEq/L. Which nursing intervention is the priority?
A) Administer a high-flow oxygen mask at 10L/min to correct hypoxemia.
B) Prepare for endotracheal intubation and mechanical ventilation.
C) Increase the dose of inhaled bronchodilators to improve alveolar ventilation.
D) Administer intravenous sodium bicarbonate to correct the pH.
Correct Answer: B) Prepare for endotracheal intubation and mechanical ventilation.
Explanation: The patient is experiencing acute-on-chronic respiratory failure with
uncompensated respiratory acidosis. The lethargy and low respiratory rate indicate impending
respiratory arrest and CO2 narcosis. High-flow oxygen is contraindicated as it suppresses the
hypoxic drive in COPD, and bicarbonate is ineffective for respiratory acidosis, which requires
improved ventilation.
Question 2: A patient recovering from a total thyroidectomy suddenly develops tingling around
the mouth, muscle spasms of the hand when the blood pressure cuff is inflated, and irritability.
Which electrolyte imbalance is most likely occurring?
A) Hyperkalemia
B) Hyponatremia
C) Hypocalcemia
D) Hypomagnesemia
Correct Answer: C) Hypocalcemia
Explanation: The symptoms describe Chvostek’s and Trousseau’s signs, which are classic
indicators of hypocalcemia. During a thyroidectomy, there is a risk of accidental damage or
, removal of the parathyroid glands, which regulate calcium levels. A sudden drop in parathyroid
hormone (PTH) leads to a rapid decline in serum calcium.
Question 3: A patient with suspected Myocardial Infarction (MI) is brought to the ED. Which of
the following findings would be most diagnostic of a non-ST-elevation myocardial infarction
(NSTEMI)?
A) ST-segment elevation on the 12-lead ECG.
B) Increased Troponin I and T levels with no ST-segment elevation.
C) Normal serum cardiac markers and a peaked T-wave.
D) Persistent ST-segment depression that resolves with nitroglycerin.
Correct Answer: B) Increased Troponin I and T levels with no ST-segment elevation.
Explanation: An NSTEMI is characterized by clinical evidence of myocardial necrosis (elevated
cardiac enzymes) in the absence of ST-segment elevation on an ECG. ST-elevation indicates an
STEMI, while stable angina is typically resolved with nitrates and does not show enzyme
elevation.
Question 4: A client with chronic heart failure (CHF) is prescribed spironolactone. The nurse
knows that the most critical instruction for this client is to:
A) Monitor for signs of hyperkalemia, such as muscle weakness and cardiac dysrhythmias.
B) Take the medication with a high-potassium diet to avoid hypokalemia.
C) Maintain strict fluid restriction to prevent rebound hypertension.
D) Stop the medication if they experience mild nausea or dizziness.
Correct Answer: A) Monitor for signs of hyperkalemia, such as muscle weakness and
cardiac dysrhythmias.
Explanation: Spironolactone is a potassium-sparing diuretic. Unlike loop or thiazide diuretics, it
inhibits the action of aldosterone, which causes the kidneys to retain potassium. Therefore, the
patient is at high risk for hyperkalemia, not hypokalemia.
Question 5: A patient with hepatic cirrhosis develops ascites and confusion. Which laboratory
result would most likely be elevated in this patient, contributing to their altered mental status?
A) Serum Albumin
B) Ammonia
Health & Complex Nursing Care Practice
Questions
Subject: Acute and Chronic Adult Health Alterations (NUR 176)
Question 1: A patient with advanced COPD presents with increasing confusion, lethargy, and a
respiratory rate of 8 breaths per minute. Arterial blood gas (ABG) results are: pH 7.24, PaCO2
68 mmHg, and HCO3 28 mEq/L. Which nursing intervention is the priority?
A) Administer a high-flow oxygen mask at 10L/min to correct hypoxemia.
B) Prepare for endotracheal intubation and mechanical ventilation.
C) Increase the dose of inhaled bronchodilators to improve alveolar ventilation.
D) Administer intravenous sodium bicarbonate to correct the pH.
Correct Answer: B) Prepare for endotracheal intubation and mechanical ventilation.
Explanation: The patient is experiencing acute-on-chronic respiratory failure with
uncompensated respiratory acidosis. The lethargy and low respiratory rate indicate impending
respiratory arrest and CO2 narcosis. High-flow oxygen is contraindicated as it suppresses the
hypoxic drive in COPD, and bicarbonate is ineffective for respiratory acidosis, which requires
improved ventilation.
Question 2: A patient recovering from a total thyroidectomy suddenly develops tingling around
the mouth, muscle spasms of the hand when the blood pressure cuff is inflated, and irritability.
Which electrolyte imbalance is most likely occurring?
A) Hyperkalemia
B) Hyponatremia
C) Hypocalcemia
D) Hypomagnesemia
Correct Answer: C) Hypocalcemia
Explanation: The symptoms describe Chvostek’s and Trousseau’s signs, which are classic
indicators of hypocalcemia. During a thyroidectomy, there is a risk of accidental damage or
, removal of the parathyroid glands, which regulate calcium levels. A sudden drop in parathyroid
hormone (PTH) leads to a rapid decline in serum calcium.
Question 3: A patient with suspected Myocardial Infarction (MI) is brought to the ED. Which of
the following findings would be most diagnostic of a non-ST-elevation myocardial infarction
(NSTEMI)?
A) ST-segment elevation on the 12-lead ECG.
B) Increased Troponin I and T levels with no ST-segment elevation.
C) Normal serum cardiac markers and a peaked T-wave.
D) Persistent ST-segment depression that resolves with nitroglycerin.
Correct Answer: B) Increased Troponin I and T levels with no ST-segment elevation.
Explanation: An NSTEMI is characterized by clinical evidence of myocardial necrosis (elevated
cardiac enzymes) in the absence of ST-segment elevation on an ECG. ST-elevation indicates an
STEMI, while stable angina is typically resolved with nitrates and does not show enzyme
elevation.
Question 4: A client with chronic heart failure (CHF) is prescribed spironolactone. The nurse
knows that the most critical instruction for this client is to:
A) Monitor for signs of hyperkalemia, such as muscle weakness and cardiac dysrhythmias.
B) Take the medication with a high-potassium diet to avoid hypokalemia.
C) Maintain strict fluid restriction to prevent rebound hypertension.
D) Stop the medication if they experience mild nausea or dizziness.
Correct Answer: A) Monitor for signs of hyperkalemia, such as muscle weakness and
cardiac dysrhythmias.
Explanation: Spironolactone is a potassium-sparing diuretic. Unlike loop or thiazide diuretics, it
inhibits the action of aldosterone, which causes the kidneys to retain potassium. Therefore, the
patient is at high risk for hyperkalemia, not hypokalemia.
Question 5: A patient with hepatic cirrhosis develops ascites and confusion. Which laboratory
result would most likely be elevated in this patient, contributing to their altered mental status?
A) Serum Albumin
B) Ammonia
